Health for all? Pasts, presents and futures of aspirations for universal healthcare.

In this special issue, we bring together anthropological and historical work that considers successive aspirations towards 'health for all': their pasts, their futures, and their diverse meanings and iterations. Across the world, hopes for providing 'health for all' were central to nation building in the long 20th century, and for international relations, particularly after the second world war and the establishment of the WHO. Health became seen as a fundamental good by citizens of North and South and has remained a central force shaping global and national politics until today. But what does 'health for all' actually mean, and how did it come to matter? In this introduction we approach 'health for all as a situated, multi-faceted phenomenon, that - while having a shared aspiration towards universality of access and equality of care - comes into focus in partial, diverse and contentious policies, programmes, projects and practices. Beyond homogenising narratives that frame 'health for all' in terms of either success or failure, the special issue highlights the diverse iterations that 'health for all' has taken on the ground for different subjects and groups of people, exploring exclusions and limitations as well as dreams and aspirations.

In the shadowlands of global health: observations from health workers in Kenya.

During the past decade, donor funding for health interventions in Kenya and other African countries has risen sharply. Focused on high-profile diseases such as HIV/AIDS, these funds create islands of intervention in a sea of under-resourced public health services. This paper draws on ethnographic research conducted in HIV clinics and in a public hospital to examine how health workers experience and reflect upon the juxtaposition of 'global' medicine with 'local' medicine. We show that health workers face an uneven playing field. High-prestige jobs are available in HIV research and treatment, funded by donors, while other diseases and health issues receive less attention. Outside HIV clinics, patient's access to medicines and laboratory tests is expensive, and diagnostic equipment is unreliable. Clinicians must tailor their decisions about treatment to the available medical technologies, medicines and resources. How do health workers reflect on working in these environments and how do their experiences influence professional ambitions and commitments?

Precarious projects: conversions of (biomedical) knowledge in an East African city.

This article explores the orientations of lay people in Kenya to science-specifically to biomedical knowledge about HIV--and their struggles to convert this knowledge into meaningful futures. In Kenya, the global response to the HIV-AIDS epidemic has resulted in a highly stratified landscape of intervention. Globally-funded treatment programs and clinical trials, focusing on HIV, channel transnational resources, expertise, and knowledge into specific sites--HIV clinics, NGOs, and research stations--inscribing these spaces as 'global' while leaving others decidedly 'local.' Rolled out in the form of 'projects,' these interventions offer resources and opportunities for a limited time only. Based on ethnographic fieldwork in the city of Kisumu, this article follows the circulation of biomedical knowledge through such projects and its conversion in ways beyond those imagined by policy-makers, as it meets the aspirations of city-dwellers and enters into local livelihoods. Mediated by nongovernmental organizations through workshops and certificates, this knowledge is both fragmentary and ephemeral. I explore the temporal and spatial implications of such knowledge for those who seek to attach themselves to it and shape their identities and futures in relation to it.

INTRODUCTION: SUSTAINING THE LIFE OF THE POLIS.

How are publics of protection and care defined in African cities today? The effects of globalization and neo-liberal policies on urban space are well documented. From London to São Paulo, denationalization, privatization, offshoring and cuts in state expenditure are creating enclaves and exclusions, resulting in fragmented, stratified social geographies (see Caldeira 2000; Ong 2006; Harvey 2006; Murray 2011). 'Networked archipelagoes', islands connected by transnational circulations of capital, displace other spatial relations and imaginaries. Spaces of encompassment, especially, such as 'the nation' or simply 'society' as defined by inclusion within a whole, lose practical value and intellectual purchase as referents of citizenship (Gupta and Ferguson 2002; Ferguson 2005). In African cities, where humanitarian, experimental or market logics dominate the distribution of sanitation and healthcare, this fragmentation is particularly stark (see, for example, Redfield 2006, 2012; Fassin 2007; Bredeloup et al. 2008; Nguyen 2012). Privilege and crisis interrupt older contiguities, delineating spaces and times of exception. The 'public' of health is defined by survival or consumption, obscuring the human as bearer of civic rights and responsibilities, as inhabitants of 'objective' material worlds 'common to all of us' (Arendt 1958: 52). Is it possible, under these conditions, to enact and imagine public health as a project of citizens, animated in civic space?

'TARMACKING' IN THE MILLENNIUM CITY: SPATIAL AND TEMPORAL TRAJECTORIES OF EMPOWERMENT AND DEVELOPMENT IN KISUMU, KENYA.

Over the past fifteen years, the city of Kisumu in western Kenya has emerged as an epicentre of 'global health' interventions, organized by non-governmental and transnational groups. These interventions involve concrete, practical engagements with the city's populations, but also imaginations and desires, as they intersect with residents' expectations of development. This article follows the hopes, aspirations and trajectories of people who attach themselves as volunteers to these interventions, or who hope to do so through a process they describe as 'tarmacking'. In exploring how volunteers orient themselves to ideas of 'empowerment' that are promoted by NGOs and also have influence outside institutional settings, it examines the relations between the landscapes of intervention, the spatial-temporal horizons, and the geographies of responsibility emergent in the city. Through its association with 'moving ahead' and with development, empowerment implies movement towards some kind of future. While there is a widely shared sense among volunteers that they are going somewhere, just where that might be is not clearly articulated. Rather than attempt to pinpoint this destination, this article follows their trajectories in an attempt to grasp why and how it remains obscure.

Au cours des quinze dernières années, la ville de Kisumu dans l'Ouest du Kenya est apparue comme un épicentre d'interventions en « santé mondiale ¼, organisé par des groupes non gouvernementaux et transnationaux. Ces interventions impliquent un engagement concret et pratique avec les populations de la ville, mais aussi avec leurs imaginations et leurs désirs, qui s'entremêlent avec les attentes des résidents en matière de développement. Cet article suit les espoirs, les aspirations et les trajectoires de personnes qui se joignent à ces interventions en tant que travailleurs de santé bénévoles, ou qui espèrent le faire à travers un processus qu'elles désignent par le terme de « tarmacking ¼. En s'intéressant à la manière dont les bénévoles s'orientent vers des idées d'« autonomisation ¼ qui sont promues par les ONG et ont également une influence en dehors des milieux institutionnels, il examine les relations entre les paysages d'intervention, les horizons spatio-temporels et les géographies de la responsabilité qui émergent dans la ville. À travers son association avec l'idée d'« aller de l'avant ¼ et de développement, l'autonomisation implique un mouvement vers une sorte de futur. Les bénévoles partagent assez largement le sentiment qu'ils vont quelque part, mais sans clairement préciser où se situe ce quelque part. Plutôt que de tenter de localiser cette destination, cet article suit des trajectoires personnelles pour tenter de comprendre pourquoi et comment elle demeure obscure.

Active compounds and atoms of society: plants, bodies, minds and cultures in the work of Kenyan ethnobotanical knowledge.

This paper examines a sequence of investigations in parasitology, botany, pharmacology, psychometrics and ethnopsychology focused on Kenyan village children's knowledge of medicinal herbs. We follow this work of making and ordering of knowledge, showing that the different disciplinary perspectives on bodies, medicines, knowledges, children and cultures produced by this research all sought the foundation of knowledge in reference to objective reality, and that they aimed to make the world known in the specific form of distinct and comparable entities with individual properties and capacities. Based on subsequent ethnographic observations of healing in the same village, we outline a different, contrasting modality of knowing, which places ontology above epistemology. Medicinal knowledge and its transformational capacity are here not located within entities but between them; not in objective reality but in effects; 'to know' means 'to come together' with the implication of having an effect on one another. We use this ethnographic sketch of a different form of knowing as a foil against which to contrast the imaginary that had shaped our previous research. Beyond the stark contrast between herbal village healing and pharmacological laboratory analysis, we expand our argument by moving from natural science to social science, from studies of plants and substances to those of humans, minds and cultures; from laboratories to ethno-psychological tests, cultural models, and eventually econometrics. We suggest that by reiterating a particular scientific imaginary, remaking humans (and non-human beings) as known things, a specific notion of man and a related political economy of knowledge is naturalized. Looking back at our involvement with this sequence of research, we realize that, contrary to our intentions, our inclusion as 'social scientists' into a multidisciplinary scientific project may have exacerbated rather than mitigated its potentially problematic effects.

Medicinal plants used by Luo mothers and children in Bondo district, Kenya.

In a follow-up to studies of school-children's medical knowledge among the rural Luo of western Kenya, seven mothers were asked for their knowledge of plant medicine, and the 91 plant remedies mentioned by them were collected, 74 of these remedies were identified as 69 different species (in 13 cases, the material did not allow identification of the species, in two cases, only the family could be identified, and in two, not even this was possible). The results of this survey and some comments on Luo illness concepts are presented below and briefly discussed in relation to the earlier work on school-children and to another survey of Luo plant medicine in the same district. The article concludes that the consensual core of Luo plant medicine is known by ordinary mothers and their children as well as by recognised healers. It is a shared resource, that is used by women, mainly in the care for their children, and it is not an expert domain of knowledge, as is often, in studies of herbal or 'traditional' medicine are studied. The medicinal plants, upon which many mothers as well as healers agree should be examined further pharmacologically in order to assess their efficacy against the common infectious and parasitic diseases found in this area of western Kenya.